JP5816774B2 - Biological tissue joining system, treatment instrument control device, and operating method of biological tissue joining system - Google Patents

Description

  Embodiments described herein relate generally to a biological tissue joining system that applies treatment energy to a biological tissue, a treatment instrument control device, and a method for operating the biological tissue joining system.

  In the specification of US Patent Application Publication No. 2009/076506, a pair of sandwiching portions that apply high-frequency power energy and thermal energy to a sandwiched object and a high-frequency power that outputs high-frequency power for applying high-frequency power energy. A power source, a heating power source that outputs heating power for applying thermal energy, a high-frequency power source for switching between high-frequency power energy application and thermal energy application, and a control unit that controls the heating power source. A biological tissue bonding system is disclosed.

  In addition, US Patent Application Publication No. 2009/0248002 discloses a biological tissue bonding system that applies high-frequency power energy to an object to be treated and applies heat energy after the application of the high-frequency power energy is completed. ing. The high-frequency power energy has an action of releasing intracellular components including a polymer compound such as protein by breaking the cell membrane of the object to be treated and making it uniform with extracellular components such as collagen. And a to-be-treated body is joined by application of heat energy.

  US 2013/19060 discloses a tissue bonding system that applies ultrasonic energy and high-frequency power energy to an object to be treated.

  U.S. Patent Application Publication No. 2005/222556 discloses a tissue bonding system that applies light energy to a treatment object using a laser.

  That is, the treatment unit of the medical treatment tool applies at least one of thermal energy, ultrasonic energy, light energy, and high-frequency power energy as treatment energy to the object to be treated.

  Here, in order for the living tissue joining system to obtain a good treatment result, it is preferable to control the amount of energy based on the temperature of the living tissue being treated. However, it was not easy to detect the temperature of the living tissue during the treatment. For this reason, in the conventional biological tissue joining system, control is performed based on the temperature of an energy output unit that is easy to detect instead of the biological tissue temperature, for example, the temperature of the heating element.

  In the conventional tissue bonding system, since control is performed based on the temperature of the energy output unit that is easy to detect, it may not be easy to perform an appropriate treatment.

US Patent Application Publication No. 2009/076506 US Patent Application Publication No. 2009/0248002 US Patent Application Publication No. 2013/19060 US Patent Application Publication No. 2005/222556

  Embodiments of the present invention include a biological tissue joining system that can easily perform an appropriate treatment, a treatment instrument control device that can easily perform an appropriate treatment, and a biological tissue joining system that can easily perform an appropriate treatment. It aims to provide a method of operation.

A living tissue bonding system according to an aspect of the present invention includes a holding portion for holding a living tissue, a power source for generating treatment energy for bonding the living tissue held by the holding portion, and the holding An output unit provided in the unit for outputting the treatment energy to the living tissue, a temperature measurement unit for measuring the temperature of the output unit, and the temperature of the output unit measured by the temperature measurement unit And a pre-stored table or expression indicating a correlation between a temperature difference between the temperature of the living tissue sandwiched by the sandwiching unit and an output value output from the power source to the sandwiching unit. A first calculation unit that estimates the temperature difference from the table or the equation based on the output value of the power source according to an energy application time; a temperature of the output unit measured by the temperature measurement unit; Before 1 calculation unit estimated And a temperature difference, and a second calculating unit that estimates a temperature of the living body tissue, the second calculating unit on the basis of the temperature of the living tissue estimated, comprising a control unit for controlling the power supply.

The treatment tool control device according to one aspect of the present invention is a treatment tool control device that controls treatment energy to the living tissue with respect to a holding portion for holding a living tissue, and the living body held by the holding portion. A power source for generating the treatment energy for joining tissues, an output unit provided in the clamping unit for outputting the treatment energy to the living tissue, and a temperature for measuring the temperature of the output unit A temperature difference between the temperature of the measurement unit, the temperature of the output unit measured by the temperature measurement unit, the temperature of the living tissue sandwiched by the sandwiching unit, and an output value output from the power source to the sandwiching unit A first calculation unit for estimating the temperature difference from the table or the formula using the table or formula stored in advance and indicating the output value from the power source according to the treatment energy application time; Temperature measurement unit From the measured temperature of the output unit and the temperature difference estimated by the first calculation unit, a second calculation unit for estimating the temperature of the biological tissue, and the temperature of the biological tissue estimated by the second calculation unit And a control unit for controlling a power source that generates electric power for the treatment energy.

In the operating method of the biological tissue joining system according to one aspect of the present invention , the power supply generates treatment energy for joining the biological tissue sandwiched between the sandwiching portions, so that the output unit provided in the sandwiching portion causes the treatment to be performed. A step of outputting energy; a step of measuring a temperature of the output unit by a temperature measuring unit; a temperature of the output unit measured by the temperature measuring unit; and a temperature of the living tissue clamped by the clamping unit. Using a pre-stored table or expression indicating the correlation between the temperature difference and the output value output from the power source to the clamping unit , the first calculation unit is configured to output the power from the power source according to the treatment energy application time. A step of estimating the temperature difference obtained from the table or the equation with an output value ; a temperature of the output unit measured by the temperature measuring unit by the second calculating unit; and the temperature estimated by the first calculating unit. Difference and Al, estimating a temperature of the living tissue, the control unit comprises the steps of: the second calculation unit controls the power supply based on the living tissue temperature estimation.

  According to the embodiments of the present invention, a biological tissue joining system that can easily perform an appropriate treatment, a treatment instrument control device that can easily perform an appropriate treatment, and a biological tissue joining that can easily perform an appropriate treatment A method of operating the system can be provided.

It is an external view of the biological tissue joining system of 1st Embodiment. It is a side view of the treatment part of the biological tissue joining system of a 1st embodiment. It is a side view of the treatment part of the biological tissue joining system of a 1st embodiment. It is sectional drawing of the treatment part of the biological tissue joining system of 1st Embodiment. It is a top view of the treatment part of the biological tissue joining system of a 1st embodiment. It is sectional drawing which followed the 3C-3C line | wire of FIG. 3A of the treatment part of the biological tissue joining system of 1st Embodiment. It is an upper surface figure of the exothermic part of the living tissue joining system of a 1st embodiment. It is a block diagram of the biological tissue joining system of 1st Embodiment. It is a graph for demonstrating the change of the tissue temperature in the biological tissue joining system of 1st Embodiment, and the change of element temperature. It is a graph which shows the relationship between the temperature difference of tissue temperature and element temperature, and the output value of electric power in the biological tissue joining system of 1st Embodiment. It is a flowchart for demonstrating the operating method of the biological tissue joining system of 1st Embodiment. It is a graph which shows the time change of the output value of the electric power for heat generation, and treatment part temperature in the living tissue joining system of a 2nd embodiment. It is a graph which shows the relationship between the temperature difference of biological tissue temperature and treatment part temperature, and the output value of the electric power for heat generation in the biological tissue joining system of a 2nd embodiment. It is a graph for demonstrating the amount of heating in the biological tissue joining system of 3rd Embodiment. It is a graph which shows the relationship between the amount of heating in the biological tissue joining system of 3rd Embodiment, and biological tissue joining strength. It is a flowchart for demonstrating the operating method of the biological tissue joining system of 3rd Embodiment. It is a block diagram of the biological tissue joining system of 4th Embodiment. It is a graph for demonstrating the biological tissue in the biological tissue joining system of 4th Embodiment, the temperature change of a treatment part, and the amount of heating. It is a flowchart for demonstrating the operating method of the biological tissue joining system of 4th Embodiment.

<First Embodiment>
<Configuration of biological tissue bonding system>
As shown in FIG. 1, the biological tissue joining system 1 of the present embodiment includes a treatment tool 2, a main body 3 that is a treatment tool control device, and a foot switch 4. The treatment instrument 2 is a surgical energy anastomosis apparatus that performs a joint treatment of living tissues in the abdominal cavity through, for example, the abdominal wall.

  The treatment instrument 2 includes a grip 2A1, a shaft 2A2, and a pair of openable and closable holding portions 11 (first holding portion 11A and second holding portion 11B) that hold a living tissue LT that is a treatment target and perform treatment. It has the treatment part 10 which becomes.

  In the following description, the symbols A and B may be omitted when referring to the components having the same function with A and B added to the end of the symbol. For example, each of the first clamping unit 11A and the second clamping unit 11B is referred to as a clamping unit 11.

  The grip 2A1 is connected to the main body 3 via the cable 2L. A grip 2A1 having an opening / closing knob 2A3 for operating the operator to open and close the treatment section 10 has a shape that is easy for an operator to grip, for example, a substantially L-shape. At one end of the grip 2A1, a shaft 2A2 that is integrated with the treatment section 10 and transmits the operation of the opening / closing knob 2A3 to the treatment section 10 is disposed. On the other hand, the other end side of the grip 2A1 is a grasping portion 2A4 grasped by the operator.

  The main body 3 has a display unit 36 for displaying treatment conditions and the like, and a setting operation unit 35 for the operator to set treatment conditions and the like on the front panel, and the foot switch 4 is connected via a cable 4L. . When the operator presses the pedal of the foot switch 4 with his / her foot, the power output from the main body 3 to the treatment instrument 2 is ON / OFF controlled. The foot switch 4 is not an essential component and may be a switch or the like that is operated by a surgeon at hand.

  As shown in FIGS. 2A and 2B, the treatment instrument 2 applies thermal energy (TH energy) to the living tissue LT via the treatment surface 11S (11SA, 11SB) which is a contact surface with the living tissue LT.

  For example, the treatment unit 10 can be opened and closed by moving the second clamping unit 11B relative to the first clamping unit 11A. As shown in FIG. 2A, when the opening / closing knob 2A3 is not pressed by the operator, the second clamping portion 11B is in the proximity or contact state with the first clamping portion 11A due to the biasing force of an elastic member (not shown). On the other hand, as shown in FIG. 2B, when the operator presses the opening / closing knob 2A3 with a force stronger than the urging force of the elastic member, the second holding portion 11B is separated from the first holding portion 11A, and the treatment is performed. Part 10 is in the open state. When the treatment section 10 is in the open state, the living tissue LT inserted between the first sandwiching section 11A and the second sandwiching section 11B is attached to the elastic member when the surgeon stops pressing the opening / closing knob 2A3. The force is held between the treatment surface 11SA of the first sandwiching portion 11A and the treatment surface 11SB of the second sandwiching portion 11B while being pressed.

  As shown in FIGS. 3A to 4, the treatment surface 11 </ b> S of the clamping unit 11 is the front surface (outer surface) of the heat transfer body 12 made of a metal such as stainless steel or copper. And the heat generating element 13 is joined to the back surface (inner surface) of the heat transfer body 12. The upper surface of the heating element 13 is covered and insulated by an insulator 16 such as polyimide.

  The heating element 13 has a heating resistor 15 formed on the surface of a substrate 14 such as alumina or aluminum nitride. The heating resistor 15 is made of platinum having a positive resistance temperature coefficient that increases the electrical resistance R as the temperature rises. Therefore, as will be described later, the element temperature measuring unit 39 can calculate the temperature T1 of the heating element 13 (heating resistor 15) from the electrical resistance R of the heating resistor 15. As the material of the heating resistor 15, various positive resistance temperature coefficient refractory metal materials such as NiCr alloy, Ta, or W may be used.

  The heat generating element 13 is an output unit that applies heat generation power (TH) output from the main body 3 to the living tissue LT as heat energy.

  Although the heat generating element 13 is disposed in each of the sandwiching portions 11A and 11B, the heat generating element 13 may be disposed in at least one of the sandwiching portions 11.

  Next, the configuration of the biological tissue bonding system 1 will be described with reference to FIG. As already described, the biological tissue joining system 1 includes the treatment tool 2, the main body 3, and the foot switch 4.

  The main body 3 includes a heating power (TH) power source 30, a heating power sensor (TH sensor) 31, a setting unit 32, a calculation unit 33, a control unit 34, a storage unit 38, and an element temperature measurement unit. 39.

  The power supply 30 outputs heat generation power (TH) for heat energy. The TH sensor 31 as a detection unit detects the output value (voltage and current) of TH. The product of voltage and current is power P.

  The control unit 34 performs overall control of the biological tissue joining system 1.

  The element temperature measuring unit 39, which is a temperature measuring unit that measures the temperature of the output unit, calculates the electrical resistance R of the heating element 13 from the voltage and current of TH, and from the calculated electrical resistance R, the heating element 13 that is the output unit. The element temperature T1 is indirectly measured by calculating the temperature (element temperature) T1. That is, the element temperature measuring unit 39 has a storage unit (not shown) in which a calculation formula based on the resistance temperature coefficient of the heating element 13 or a correspondence table between the electric resistance R and the element temperature T1 is stored. The element temperature measuring unit 39 may calculate the element temperature T1 directly without calculating the electric resistance R from the voltage and current of TH. The element temperature measuring unit 39 may directly measure the element temperature T1 with a temperature sensor such as a thermocouple disposed in the vicinity of the heating element 13.

  As shown in FIG. 6, there is a temperature difference ΔT between the element temperature T1 and the temperature of the living tissue (tissue temperature) T2. The temperature difference ΔT changes as the treatment time elapses. For this reason, it may not be easy to perform an appropriate measure in the control based on the element temperature T1.

  As a result of earnest research, the inventor found that the temperature difference ΔT has a strong correlation with the output value P of the heat generation power (TH) as shown in FIG. This is because the output value P is controlled at a constant temperature so that the element temperature T1 becomes the predetermined element temperature set value Tset, and therefore, if the temperature difference ΔT is large, a larger TH of the output value P is required. .

  In the biological tissue joining system 1, the storage unit 38 has a table (table data) for estimating the temperature difference ΔT between the element temperature T1 and the biological tissue temperature T2 based on the output value of the power supply 30. Or an expression is stored.

  For this reason, T2 is computable from the following (Formula 1).

  T2 = T1-ΔT = T1-f (P) (Formula 1)

  FIG. 7 shows a straight line obtained by approximating a plurality of experimental data (plots) by a least square method based on ΔT obtained by actually measuring the temperature of a living tissue using a temperature sensor. .

  That is, the straight line expression f (P) shown in FIG. 6 is ΔT = αP + β (α: inclination, β: Y intercept). The expression f (P) may be a quadratic expression or the like, or the electric power P may be divided into a plurality of ranges and may be composed of a plurality of different expressions for each section. In the case of storing in a table, for example, ΔT corresponding to every 5 W of power P is stored in the table.

  Different formulas f (P) may be stored depending on the type of living tissue. The tissue temperature T2 is not limited to the internal temperature of the living tissue, and may be a surface temperature in contact with the treatment surface 11S.

  The calculation unit 33 calculates the temperature T2 of the living tissue being treated. Hereinafter, for convenience of explanation, the calculation unit 33 will be described by dividing it into a first calculation unit 33A and a second calculation unit 33B according to its function.

  The first calculation unit 33A estimates the temperature difference ΔT using a stored table or expression stored in advance based on the output value P of the power supply 30.

  The second calculation unit 33B estimates the tissue temperature T2 using (Equation 1) from the element temperature T1 measured by the element temperature measurement unit 39 and the temperature difference ΔT estimated by the first calculation unit 33A.

  The setting unit 32 sets a treatment condition based on the operation of the setting operation unit 35 or the like. In the biological tissue bonding system 1, the setting unit 32 includes a storage unit 32M. The storage unit 32M including a semiconductor memory or the like may store a plurality of treatment conditions according to the type of living tissue, for example. The setting operation unit 35 can be regarded as a part of the broad setting unit 32S.

  The CPU or the like constituting the control unit 34 may have at least a part of the functions of the element temperature measurement unit 39, the calculation unit 33, and the setting unit 32. Moreover, each may be an independent CPU. Further, the storage unit 38 made of a semiconductor memory or the like may have the functions of the storage unit 32M of the setting unit and the storage unit of the calculation unit 33. Conversely, the calculation unit 33 may include a semiconductor memory having the function of the storage unit 38.

  The display unit 36 is a notification unit that notifies the surgeon of information such as the set treatment condition, the output value of the power being treated, and the tissue temperature T2.

  In the biological tissue joining system 1, the control unit 34 controls the power supply 30 based on the tissue temperature T2 estimated by the second calculation unit 33B.

<Operation method of biological tissue bonding system>
Next, the operation method of the biological tissue bonding system 1 will be described along the flowchart of FIG.

<Step S11>
For example, the following treatment conditions are set via the setting unit 32 including the setting operation unit 35.

Tissue temperature set value Tset: 190 ° C
Maximum temperature Tmax: 200 ° C
Treatment time t: 10 seconds

  Here, the tissue temperature set value Tset is a target temperature that the controller 34 performs constant temperature control. The upper limit temperature Tmax is a temperature at which the biological tissue being treated may be damaged unexpectedly and may begin to adversely affect the surrounding site.

  As already described, the element temperature T1 is set as the target temperature for constant temperature control in the conventional biological tissue bonding system, whereas in the biological tissue bonding system 1, the tissue temperature T2 is set.

<Step S12>
As shown in FIG. 2A, the closed treatment unit 10 is inserted into the abdominal cavity through, for example, the abdominal wall. When the surgeon performs a pressing operation for grasping the opening / closing knob 2A3 of the grip 2A1, the second holding part 11B opens with respect to the first holding part 11A. Then, the treatment target living tissue LT is disposed between the treatment surface 11SA of the first sandwiching portion 11A and the treatment surface 11SB of the second sandwiching portion 11B. In this state, when the opening / closing knob 2A3 is opened, the second clamping part 11B is closed with respect to the first clamping part 11A by the biasing force of the elastic member, and as shown in FIG. Then, it is sandwiched in a pressed state between the treatment surface 11SA of the first sandwiching portion 11A and the treatment surface 11SB of the second sandwiching portion 11B.

<Step S13>
The surgeon presses the foot switch 4 with his / her foot. Then, the control unit 34 controls the TH power supply 30 to output the heat generation power (TH).

<Step S14>
The element temperature measuring unit 39 calculates the electric resistance R of the heat generating element 13 from the output value P (voltage and current) of the heat generating power, and calculates the temperature (element temperature) T1 of the heat generating element from the calculated electric resistance R.

  In the biological tissue bonding system 1, the element temperature T1 is calculated by regarding the average temperature of the heating elements 13A and 13B or the temperature of one of the heating elements 13A and 13B as the element temperature T1.

<Step S15>
Based on the output value P, the first calculator 33A estimates the temperature difference ΔT using a table or formula stored in advance.

<Step S16>
The second calculating unit 33B estimates the tissue temperature T2 using (Equation 1) from the element temperature T1 measured by the element temperature measuring unit 39 and the temperature difference ΔT estimated by the first calculating unit 33A.

<Step S17>
The control unit 34 stops the treatment when the tissue temperature T2 exceeds the upper limit temperature Tmax. At this time, it is preferable that the control unit 34 displays a warning on the display unit 36.

<Step S18>
The control unit 34 stops the treatment when the foot switch 4 is not pressed (SW OFF: Yes). Until then, the procedure from step S13 is repeated.

  In the operation method 1 of the biological tissue joining system 1, the main body 3 (treatment tool control device), and the biological tissue joining system, control is performed based on the temperature T2 of the biological tissue that is actually being treated. For this reason, the tissue temperature T2 does not exceed the upper limit temperature Tmax. In addition, it is possible to perform more appropriate treatment than the conventional treatment system controlled by the element temperature or the like.

<Modification of First Embodiment>
Next, the biological tissue joining systems 1A to 1C, the treatment instrument control device, and the operation method of the biological tissue joining system according to the first to third modifications of the first embodiment will be described. Hereinafter, (the biological tissue joining system, the treatment instrument control device, and the operation method of the biological tissue joining system 1) are referred to as a biological tissue joining system or the like. The biological tissue bonding systems 1A to 1C and the like are similar to the biological tissue bonding system 1 and the like.

  In the biological tissue bonding system 1, the applied treatment energy is thermal energy. However, if the treatment energy is one of thermal energy, ultrasonic energy, light energy, and high-frequency power energy, the same effect can be obtained.

<Modification 1>
In the biological tissue joining system 1A and the like according to the first modification, laser light that is light energy is applied to the biological tissue as treatment energy. That is, the power source outputs power to a light source that generates laser light.

  The living tissue to which the laser light is applied generates heat. A specific treatment site can be selectively heated by selecting the wavelength of the laser beam.

<Modification 2>
In the biological tissue joining system 1B and the like according to Modification 2, ultrasonic energy is applied as treatment energy to the biological tissue. That is, the power source outputs power to the ultrasonic transducer.

  The treatment tool of the biological tissue joining system 1B has an ultrasonic vibrator inside the grip 2A1, and the sandwiching portion 11A vibrates ultrasonically. The living tissue held between the fixed holding part 11B generates heat due to frictional heat.

<Modification 3>
In the biological tissue bonding system 1C and the like according to Modification 3, high-frequency power energy is applied as treatment energy to the biological tissue. That is, the power source outputs high frequency power.

  The heat transfer body made of metal of the treatment tool of the living tissue bonding system 1C has a function as an electrode for applying high frequency power (HF) to the living tissue. When high frequency power is applied to the living tissue LT sandwiched between the electrodes 12A and 12B, the living tissue LT is heated by Joule heat.

  As for the operation methods of the biological tissue bonding systems 1A to 1C, the treatment instrument control device, and the biological tissue bonding system according to the modification of the first embodiment, the temperature T1 of the output unit is the same as in the biological tissue bonding system 1 Then, the output value P of the power source is measured, the temperature difference ΔT is estimated from the temperature T1 and the output value P, and the tissue temperature T2 is estimated from the temperature difference ΔT.

When the tissue temperature T2 exceeds the upper limit temperature Tmax, the treatment is stopped.
That is, the control unit 34 controls the power supply 30 so that the tissue temperature T2 estimated by the second calculation unit 33B does not exceed the upper limit temperature Tmax. For this reason, it is easy to perform appropriate treatment for any of the biological tissue bonding systems 1A to 1C of the modified example.

Second Embodiment
Next, a biological tissue bonding system 1D and the like according to the second embodiment will be described. Since the biological tissue bonding system 1D and the like are similar to the biological tissue bonding system 1 and the like, components having the same functions are denoted by the same reference numerals and description thereof is omitted.

  In the biological tissue bonding system 1D, for example, the storage unit 38 of the treatment instrument control device 3D sets the temperature difference ΔT based not only on the output value P of the power supply 30, but also on the output value P and the temperature T1 of the output unit (heating element 13). A table or expression for estimation is stored, and the first calculation unit 33A estimates the temperature difference ΔT based on the output value P of power and the temperature T1 of the output unit.

  That is, in the biological tissue bonding system 1D, the first calculation unit 33A determines the temperature difference ΔT, the element temperature T1 of the heating element 13, and the output value P of the heating power (TH) in step S15 illustrated in FIG. Calculate from.

  As already described, the temperature difference ΔT between the tissue temperature T2 and the element temperature T1 has a strong correlation with the output value P of the heat generation power (TH). Then, by considering not only the output value P but also the element temperature T1, the temperature difference ΔT can be estimated more accurately.

  ΔT = f (P, T1) (Formula 2)

  As shown in FIG. 9, immediately after the start of the heat treatment (initial period L1), the element temperature T1 rises very slowly to such an extent that it can be regarded as substantially constant due to the heat capacity of the heating element 13 itself. On the other hand, while the heating element 13 is being heated (temperature rising period L2), the element temperature T1 is significantly lower than the temperature set value Tset. For this reason, the output value P increases rapidly. When the element temperature T1 comes close to the temperature set value Tset (temperature increase completion period L3), the output value P starts to decrease in order to prevent overshoot. When the element temperature T1 becomes stable, the output value P Further decreases to a substantially constant value (stable period L4).

  FIG. 10 plots the relationship between the output value P and the temperature difference ΔT by distinguishing the above four periods. That is, data for the period L1 is plotted with black triangle marks, data for the period L2 with black circle marks, data for the period L3 with white circle marks, and data for the period L4 with white triangle marks.

  As is clear from FIG. 10, when calculating the temperature difference ΔT from the output value P, it is possible to calculate with higher accuracy by changing the calculation formula according to the four periods. Here, the first calculator 33A determines the four periods L1 to L4 from the element temperature T1 or the output value P.

  That is, the period L1 is immediately after the start of the rise of the element temperature T1, the period L2 is during the rise, the element temperature T1 is close to the element temperature set value Tset, the output value P is decreased, and the decrease rate is the predetermined value or less. Until this is the period L3, the period thereafter is the period L4.

  The calculation formula for each period can be set as appropriate. For example, ΔT may be regarded as constant in the period L1, and linear approximation may be performed in the periods L2 to L4. Moreover, you may distinguish in five or more periods, and you may distinguish in three or less periods.

  Since the biological tissue bonding system 1D and the like can estimate the temperature difference ΔT with higher accuracy than the treatment system 1 and the like, more appropriate treatment can be performed.

  Note that the temperature difference ΔT may be affected by the pressing force PP between the treatment surface 11SA of the first clamping unit 11A and the treatment surface 11SB of the second clamping unit 11B. For this reason, it is possible to estimate the temperature difference ΔT with higher accuracy by disposing a pressure sensor on the treatment surface 11S and using the pressing force PP to estimate the temperature difference ΔT. Note that the temperature difference ΔT is constant when the pressing force PP is equal to or higher than a predetermined pressure. For this reason, the control unit 34 may control the power supply 30 so that the treatment is not started when the pressing force PP is less than the predetermined pressure.

<Third Embodiment>
Next, the biological tissue joining system 1E according to the third embodiment will be described. Since the biological tissue joining system 1E and the like are similar to the biological tissue joining system 1 and the like, the same reference numerals are given to components having the same functions, and description thereof will be omitted.

  In the biological tissue joining system E, the calculation unit 33 of the treatment instrument control device 3E calculates a heating amount Q that is a time integral value of the tissue temperature T2, and the control unit 34 determines that the heating amount Q is a predetermined heating amount. When the set value Qset or more is reached, the power supply 30 is controlled so as to reduce or end the output of power. That is, in the living tissue bonding system 1 or the like, the completion of the treatment is controlled based on, for example, a preset treatment time, but in the living tissue bonding system 1E, it is controlled based on the heating amount Q.

  In order to obtain a good treatment result, it is necessary to appropriately apply the treatment energy application time. When the application time is short, the bonding strength is insufficient, and when the application time is long, the surrounding tissue is adversely affected, or the bonding strength is insufficient.

  The heating amount Q is a time integral value of the temperature, that is, the product of the temperature and the application time, and is expressed in units of “° C. seconds”, for example. For example, the heating amount Q from the start of treatment (time 0) to time t1 is calculated by the following (formula 3) (see FIG. 11). Note that the lower limit temperature Tmin in FIG. 11 will be described later.

(Formula 3)

  The heating amount Q can also be expressed as an integrated value (integrated temperature) with a unit of “° C.” obtained by adding the biological tissue temperature T2 every predetermined time, for example, every second. That is, the time integral value of temperature and the integrated temperature are physical quantities indicating the same state, although the units are different. The heating amount Q is a physical quantity that is completely different from the calorie in units of joules.

  FIG. 12 shows the relationship between the heating amount Q and the bonding strength of the treated living tissue LT. From FIG. 12, it is clear that a good treatment result can be obtained by using the heating amount Q as a reference. That is, if the heating amount Q is equal to or greater than the predetermined heating amount QA, a practically sufficient bonding strength SA can be obtained. The heating amount QA is previously tested, and the obtained experimental value is stored in the storage unit 32M.

<Operation method of biological tissue bonding system>
Next, an operation method of the biological tissue joining system 1E will be described along the flowchart of FIG.

<Step S21>
For example, the following treatment conditions are set via the setting unit 32 including the setting operation unit 35.

Tissue temperature set value Tset: 220 ° C
Heating amount set value Qset: 800 ° C. Lower limit temperature Tmin: 50 ° C.
Maximum temperature Tmax: 230 ° C

  Here, the lower limit temperature Tmin is a temperature at which the biological tissue starts to change. In other words, the living tissue is not substantially treated until the lower limit temperature Tmin is reached.

  As described above, in the conventional tissue joining system, the treatment time (application time of application of treatment energy) is set as the treatment condition, whereas in the living tissue joining system 1, the heat at the tissue temperature T2 is set. A heating amount setting value Qset, which is a time integration value until the end of energy application, is set.

  The treatment condition can be set by the operator according to the treatment from among a plurality of treatment conditions stored in the storage unit 32M, for example, but as will be described later, the setting unit 32 according to the type of the living tissue LT. May be set automatically.

  That is, each condition may be set individually, or may be selected as a treatment condition set in which a plurality of conditions are set in advance. For example, as described below, a plurality of treatment condition sets LV1 to LV3 may be stored in the storage unit 32M in advance according to the type of living tissue LT to be treated.

(LV1)
Tissue temperature set value Tset: 180 ° C
Heating amount set value Qset: 1000 ° C. Lower limit temperature Tmin: 50 ° C.
Maximum temperature Tmax: 190 ° C

(LV2)
Tissue temperature set value Tset: 190 ° C
Heating amount set value Qset: 2500 ° C. Second lower limit temperature Tmin: 50 ° C.
Maximum temperature Tmax: 200 ° C

(LV3)
Tissue temperature set value Tset: 200 ° C
Heating amount set value Qset: 3500 ° C. Lower limit temperature Tmin: 50 ° C.
Maximum temperature Tmax: 210 ° C

<Step S22 to Step S27>
Since it is substantially the same as step S12 to step S17 shown in FIG.

<Step S28>
The control unit 34 determines whether the tissue temperature T2 has risen to the lower limit temperature Tmin or higher. If it becomes more than minimum temperature Tmin (YES), it will shift to Step S16. That is, the heating amount Q is not calculated during the period lower than the lower limit temperature Tmin (between time 0 and t0).

<Step S29>
The calculation unit 33 calculates a heating amount Q that is a time integral value of the tissue temperature T2.

  As for the heating amount Q shown in (Equation 3), ΔQ (tissue temperature T2 × 1 second) is added to the heating amount Q so far every predetermined time, for example, every second.

  Even if the same control is performed based on the heating amount that is the time integral value of the element temperature T1 of the heating element 13, a better treatment result can be obtained as compared with the conventional control based on the time. However, in order to perform a more accurate treatment, it is preferable to control using the tissue temperature T2.

<Step S30>
When the heating amount Q becomes equal to or higher than the heating amount set value Qset (YES), the control unit 34 controls the TH power source 30 and ends the output of TH. That is, based on the heating amount set value Qset and the heating amount Q, the output of TH ends. The control unit 34 may control the TH power source 30 to reduce the TH output to a level that does not substantially affect the living tissue.

  Since the application time of heat energy is controlled based on the heating amount Q, the biological tissue bonding system 1E can easily obtain a good treatment result. That is, the operation method of the biological tissue bonding system 1E and the like has good operability.

  Further, the ratio Q / Qset of the heating amount Q calculated by the calculating unit 33 to the heating amount set value Qset is preferably displayed on the notification unit 36B of the display unit 36. For example, the state of treatment progress is displayed by a bar graph on the notification unit 36B. The surgeon can check the progress of the treatment by displaying the notification unit 36B.

  Note that the notification of the ratio Q / Qset to the surgeon is not limited to the notification unit 36B of the display unit 36 as long as the surgeon can recognize the sound (voice information, melody type, frequency change). ), Or a notification unit that notifies by vibration intensity or the like.

<Fourth embodiment>
Next, a biological tissue bonding system 1F and the like according to the fourth embodiment will be described. Since the biological tissue bonding system 1F and the like are similar to the biological tissue bonding systems 1 and 1D and the like, components having the same functions are denoted by the same reference numerals and description thereof is omitted.

  The treatment tool 2F of the biological tissue joining system 1F sequentially applies high-frequency power energy (HF energy) and thermal energy (TH energy) to the biological tissue LT via the treatment surfaces 11SA and 11SB.

  The HF energy has an action of releasing intracellular components including a high molecular compound such as a protein by homogenizing a cell membrane of a living tissue and making it uniform with extracellular components such as collagen. Moreover, HF energy also has the effect | action which raises the temperature of a biological tissue. Then, the homogenization of the living tissue and the temperature rise promote the dehydration treatment and the joining of the living tissue by the application of the thermal energy performed thereafter.

  As shown in FIG. 14, the heat transfer body made of metal of the treatment tool 2F of the biological tissue joining system 1F also has a function as the electrode 12. The main body 3F, which is a treatment instrument control device, includes a high frequency power (HF) power source 30A that is a first power source, a heating power (TH) power source 30B that is a second power source, an HF sensor 31A, and a TH sensor 31B. And a setting unit 32, a calculation unit 33, and a control unit 34.

  The HF power source 30A outputs high frequency power (HF) that is first power. The TH power source 30B outputs heat power (TH) that is second power. Note that the HF power supply 30A and the TH power supply 30B do not output power at the same time, and thus may be a single shared power supply. In this case, the HF sensor 31A and the TH sensor 31B may be shared.

  The HF sensor 31A as the first detection unit detects the output value (voltage and current) of HF. The TH sensor 31B, which is the second detection unit, detects the output value (voltage and current) of TH.

<Operation method of biological tissue bonding system>
As shown in FIG. 15, in the biological tissue joining system 1F, application of TH energy is started after the application of HF energy (time t = t1). Then, the control unit 34 controls the end of treatment (time t = t2) based on the time integral value of the tissue temperature T2 defined by the heating amount Q.

  That is, a total heating amount QT that is an addition value of the high-frequency power energy heating amount (first heating amount) Q1 by applying HF energy and the thermal energy heating amount (second heating amount) Q2 by applying TH energy is set in advance. When the heating amount becomes equal to or greater than the set value Qset (time t = t2), the control unit 34 controls the TH power supply 30B to end the TH energy application. That is,

  Qset ≦ Q1 + Q2 (Formula 4)

  Next, the operation method of the biological tissue bonding system 1F will be described in detail along the flowchart of FIG.

<Step S31>
For example, the following treatment conditions are set by the setting unit 32 including the setting operation unit 35.

HF output set value Pset: 60W
HF termination impedance Zset: 120Ω
Element temperature set value Tset: 180 ° C
Heating amount set value Qset: 1000 ° C second

  The element temperature set value Tset is set to be higher than 70 ° C., for example, higher than 100 ° C., higher than the tissue temperature at the end of HF application (100 ° C. ± 30 ° C.).

  Similarly to the living tissue bonding system 1D and the like, a lower limit temperature Tmin and an upper limit temperature Tmax are also set, and the control unit 34 performs control based on the lower limit temperature Tmin and the upper limit temperature Tmax. However, since the control is the same as that of the biological tissue bonding system 1D and the like, description thereof is omitted.

  The setting unit 32 may automatically set the heating amount setting value Qset according to the characteristics of the living tissue LT held between the pair of holding units 11.

  For example, the heating amount set value Qset is automatically set based on at least one of the gap G between the pair of holding portions 11A and 11B where the living tissue LT is held and the initial impedance of HF.

  The interval G is information on the size of the living tissue LT that is the object to be treated. The initial impedance of HF is tissue information including the moisture content of the living tissue LT. Further, as the initial impedance of HF, a minimum impedance value, a time when the impedance is equal to or less than a predetermined value, or the like can be used.

  Further, when the surgeon selects a technique using the setting operation unit 35, a treatment condition for a series of treatments is set by the setting unit 32. For example, when the treatment A is completed, the setting unit 32 automatically sets the treatment conditions for the treatment B. It may be set. For example, when the surgical procedure is “lobe lobectomy”, (treatment A) pulmonary lobule artery sealing, (treatment B) pulmonary lobule vein sealing, (treatment C) pulmonary lobe bronchial sealing, (treatment D) When the real organ sealing between the lung lobes is sequentially performed in sequence, a series of treatment conditions (treatment A) to (treatment D) are set only by the surgeon selecting an operation method. Is good.

<Step S32>
The living tissue LT to be treated is sandwiched in a pressed state between the treatment surface 11SA of the first sandwiching portion 11A and the treatment surface 11SB of the second sandwiching portion 11B.

<Step S33>
The operator presses the foot switch 4 with his / her foot while the living tissue LT is held between the treatment sections 10. Then, the control unit 34 starts treatment. That is, the control unit 34 first controls the HF power source 30A to output high frequency power (HF). HF is transmitted to the electrodes 12A and 12B of the treatment instrument 2 via the cable 2L. Then, high frequency power is applied to the living tissue LT sandwiched between the electrodes 12A and 12B, and the living tissue LT is heated by Joule heat.

  That is, the HF energy causes the living tissue itself in the HF energization path between the electrode 12A and the electrode 12B to generate heat. For this reason, in the HF energy application step, the tissue temperature T2 rises without causing temperature unevenness to the center even if the living tissue LT is thick. Although the treatment unit 10 does not generate heat, the element temperature T1 also rises due to heat transfer from the generated living tissue LT.

  Based on the HF current and voltage detected by the HF sensor 31A, the control unit 34 performs constant power control on the HF output value P1 with an HF output set value Pset, for example, 60W.

<Step S34>
The calculation unit 33 measures the tissue temperature T2 with the temperature sensor 19 inserted into the living tissue LT, an infrared sensor, or the like, and the high-frequency power heating amount (first heating amount) that is a time integral value (integrated value) of the tissue temperature T2. ) Calculate Q1.

  Here, as shown in FIG. 15, the tissue temperature T2 at the time of HF energy application can be considered constant after the initial rapid increase because the living tissue LT contains water. That is, even when energy is applied, the temperature of the living tissue LT including water is maintained at a temperature near the boiling point (100 ° C.), which is a constant temperature at atmospheric pressure, for example, 100 ° C. ± 30 ° C.

  For this reason, the first heating amount Q1 up to the time t after the start of treatment may be calculated by the following (Formula 5) without using a sensor or the like.

Q1≈T2 × t≈100 ° C. × t (Formula 5)

  Further, the calculation (step S34) of the first heating amount Q1 by the calculation unit 33 may be performed using the following (formula 6) after step S36 described later.

Q1 = 100 ° C. × t1 (Formula 6)
However, t1; HF energy application time

  As described above, in S34, the first heating amount Q1, which is a time integral value, is calculated by considering the tissue temperature T2 as a predetermined constant temperature (100 ° C.) while applying constant power control to HF and applying HF energy. May be.

<Step S35>
In the tissue bonding system 1F, when the application of HF energy is started, the impedance Z is calculated by the calculation unit 33 from the voltage and current of HF detected by the HF sensor 31A.

  Impedance Z rises due to dehydration and the like accompanying the degeneration of the living tissue LT as the treatment progresses. The control unit 34 performs the processing from S33 until the impedance Z is set to be equal to or higher than the HF end impedance Zset (No).

<Step S36>
When the impedance Z becomes equal to or higher than the set HF end impedance Zset (YES), the control unit 34 controls the HF power source 30A and ends the output of HF in S26 (t = t1).

  That is, based on the impedance Z of HF, the output of HF ends.

<Step S37>
The control unit 34 starts control to apply TH energy to the living tissue LT instead of HF energy.

  In TH energy application, the control unit 34 controls the output value P2 of the TH power supply 30B at a constant temperature based on the element temperature T1 of the treatment unit 10. In other words, the heat generating element 13 is controlled so as to have the element temperature set value Tset set in S31. TH may be direct current or high frequency, and the frequency in the case of high frequency may be the same as HF.

  Note that the control unit 34 may perform constant temperature control on the output value P2 of the TH power source 30B based on the tissue temperature T2 as in the treatment system 1 or the like.

  The high frequency power (HF) applied from the electrode 12 to the living tissue LT heats the living tissue LT as Joule heat, whereas the heating power (TH) directly transfers heat energy to the living tissue LT. To do. The heat (TH) energy transferred to the living tissue LT via the treatment surface 11S is set to 100 ° C. according to the element temperature setting value Tset regardless of the denatured state of the living tissue LT, for example, the water content. It can be heated to a super temperature.

<Step S38>
The calculation unit 33 calculates a second heating amount (thermal energy heating amount) Q2, which is a time integral value of the tissue temperature T2. That is, in S38, the element temperature measurement unit 39 (not shown) calculates the element temperature T1 from TH and the electric resistance R, controls the temperature constant based on the element temperature T1, and applies thermal energy to the living tissue LT. Then, the first calculation unit 33A estimates the temperature difference ΔT using the second table or the second formula stored in the storage unit 38 (not shown) based on the output value of the power supply 30B. The second table and the second expression show the temperature difference ΔT2 between the temperature T1B of the heating element to which TH power is applied and the temperature (tissue temperature) T2 of the living tissue to which TH energy is applied, and the output value of the TH power source. It is the table | surface or formula acquired beforehand based on experiment for estimating based on P2.

<Step S39>
The control unit 34 stops the treatment when the tissue temperature T2 exceeds the upper limit temperature Tmax.

<Step S40>
The calculation unit 33 calculates a second heating amount Q2 that is a time integral value of the tissue temperature T2. Further, the calculation unit 33 calculates a total heating amount QT obtained by adding the first heating amount Q1 and the second heating amount Q2.

<Step S41>
When the total heating amount QT becomes equal to or greater than the heating amount set value Qset (YES), the control unit 34 controls the TH power source 30B and ends the output of TH (t = t2). That is, based on the heating amount set value Qset and the total heating amount QT, the output of TH ends.

Here, since the first heating amount Q1 has already been calculated and does not increase or decrease in the steps after S36, the control unit 34 determines that the TH heating amount ΔQ shown in the following (Equation 7) becomes TH. The output may be terminated.
Heating remaining amount ΔQ = heating amount set value Qset−first heating amount Q1−second heating amount Q2 (Expression 7)

  Note that the controller 34 may calculate the total heating amount QT or the remaining heating amount ΔQ. Further, the heating amount Q may be calculated only in the TH applying step without calculating the heating amount Q in the HF applying step.

  The biological tissue bonding system 1F and the like can easily obtain a good treatment result because the energy application time, that is, the end of energy application is controlled using the heating amount Q of the biological tissue temperature T2. For this reason, the biological tissue joining system 1F and the like have good operability.

  In the above description, the case where the first energy applied first is high-frequency power energy and the second energy applied next is thermal energy has been described. However, if the first energy is any one of high-frequency power energy, thermal energy, light energy, and ultrasonic energy, and the second energy is any energy different from the first energy, the same effect is obtained. Can be obtained.

  That is, the treatment tool sequentially applies two or more treatment energy selected from thermal energy, ultrasonic energy, light energy, and high-frequency power energy to the living tissue, and the control unit applies at least one of the treatment energy. The biological tissue joining system that performs output reduction or termination based on the heating amount has the same effect as the biological tissue joining system 1E.

  For example, a biological tissue joining system that stops a blood vessel by applying ultrasonic energy after the blood vessel is stopped by applying HF energy has the same effect by performing the same control as that of the biological tissue joining system 1D.

  In addition, the bipolar treatment tool in which the living tissue LT is grasped by the pair of sandwiching portions 11 has been described. However, even a monopolar treatment tool is a living tissue joining system that is similarly controlled based on the total heating amount QT. Good treatment results can be easily obtained.

  The present invention is not limited to the above-described embodiments and the like, and various changes and modifications can be made without departing from the scope of the present invention.

  This application is filed on the basis of application claim No. 61 / 861,683, filed in the United States on August 2, 2013, and the above disclosure is disclosed in the present specification, claims, It shall be cited in the drawing.

DESCRIPTION OF SYMBOLS 1, 1A-1F ... Biological tissue joining system 2 ... Treatment tool 3 ... Main-body part (treatment tool control apparatus)
DESCRIPTION OF SYMBOLS 13 ... Heating element 19 ... Temperature sensor 30 ... Power supply 33 ... Calculation part 33A ... 1st calculation part 33B ... 2nd calculation part 34 ... Control part 39 ... Element Temperature measurement unit

Claims (19)

A clamping part for clamping the biological tissue;
A power source for generating treatment energy for joining the living tissue sandwiched between the sandwiching portions;
An output unit provided in the sandwiching unit for outputting the treatment energy to the living tissue;
A temperature measuring unit for measuring the temperature of the output unit;
A correlation between a temperature difference between the temperature of the output unit measured by the temperature measuring unit and the temperature of the living tissue held by the holding unit and an output value output from the power source to the holding unit is shown. Using a prestored table or equation, a first calculator for estimating the temperature difference from the table or equation based on the output value of the power source according to the treatment energy application time;
A second calculation unit that estimates the temperature of the living tissue from the temperature of the output unit measured by the temperature measurement unit and the temperature difference estimated by the first calculation unit;
A control unit for controlling the power source based on the temperature of the living tissue estimated by the second calculation unit;
A biological tissue bonding system comprising:   The living tissue joining system according to claim 1, wherein the treatment energy is at least one of thermal energy, ultrasonic energy, optical energy, and high-frequency power energy.   The biological tissue bonding system according to claim 2, wherein the control unit controls the power supply so that the temperature of the biological tissue estimated by the second calculation unit does not exceed a predetermined upper limit temperature. The treatment energy is thermal energy;
The living tissue joining system according to claim 3, wherein the output unit is a heating element that converts the electric power into the thermal energy.   The control unit controls the power supply to reduce or end the output of the power when a heating amount, which is a time integral value of the temperature of the living tissue, is equal to or higher than a predetermined heating amount setting value. The biological tissue bonding system according to claim 4.   The biological tissue according to claim 2, wherein the treatment instrument sequentially applies two or more treatment energy selected from thermal energy, ultrasonic energy, optical energy, and high-frequency power energy to the biological tissue. Joining system.   The biological tissue bonding system according to claim 1, wherein the control unit is electrically connected to a storage unit in which data of the temperature difference obtained according to the treatment energy is accumulated.   A treatment instrument control device for controlling treatment energy to the living tissue with respect to a sandwiching portion for sandwiching the living tissue,
  A power source for generating the treatment energy for joining the living tissue sandwiched between the sandwiching portions;
  An output unit provided in the sandwiching unit for outputting the treatment energy to the living tissue;
  A temperature measuring unit for measuring the temperature of the output unit;
  A correlation between a temperature difference between the temperature of the output unit measured by the temperature measuring unit and the temperature of the living tissue held by the holding unit and an output value output from the power source to the holding unit is shown. Using a table or formula stored in advance, a first calculator that estimates the temperature difference from the table or formula based on the output value from the power source according to the treatment energy application time;
  A second calculation unit that estimates the temperature of the living tissue from the temperature of the output unit measured by the temperature measurement unit and the temperature difference estimated by the first calculation unit;
  A control unit that controls a power source that generates electric power for the treatment energy based on the temperature of the living tissue estimated by the second calculation unit;
  A treatment instrument control device comprising:   A power source generating treatment energy for joining the biological tissues held in the holding unit, and an output unit provided in the holding unit outputs the treatment energy; and
  A temperature measuring unit measuring the temperature of the output unit;
  A correlation between a temperature difference between the temperature of the output unit measured by the temperature measuring unit and the temperature of the living tissue held by the holding unit and an output value output from the power source to the holding unit is shown. Using a table or formula stored in advance, a first calculating unit estimating the temperature difference obtained from the table or formula based on the output value from the power source according to the treatment energy application time; and
  A second calculating unit estimating the temperature of the living tissue from the temperature of the output unit measured by the temperature measuring unit and the temperature difference estimated by the first calculating unit;
  A control unit controlling the power supply based on the biological tissue temperature estimated by the second calculation unit;
  A method for operating a biological tissue bonding system, comprising:   The method for operating a living tissue bonding system according to claim 9, wherein the treatment energy is at least one of thermal energy, ultrasonic energy, optical energy, and high-frequency power energy.   The operation of the biological tissue joining system according to claim 10, wherein the control unit controls the power supply so that the temperature of the biological tissue estimated by the second calculation unit does not exceed a predetermined upper limit temperature. Method.   The treatment energy is thermal energy;
  The operating method of the biological tissue bonding system according to claim 10, wherein the front output unit is a heating element that converts the electric power into the thermal energy.   The control unit controls the power supply to reduce or end the output of the power when a heating amount, which is a time integral value of the temperature of the living tissue, is equal to or higher than a predetermined heating amount setting value. The operating method of the biological tissue joining system according to claim 12.   The living body according to claim 10, wherein the treatment tool sequentially applies two or more treatment energy selected from thermal energy, ultrasonic energy, light energy, and high-frequency power energy to the living tissue. How to operate the tissue joining system.   The said 1st calculation part estimates the said temperature difference using the table | surface or formula memorize | stored beforehand in order to estimate based on the output value of the said power supply, and the temperature of the said output part. The operating method of the biological tissue joining system of Claim 9. The control unit sets an output value from the power source for a first period, which is a period in which the temperature of the output unit rises immediately after the start of output of the treatment energy, as a first output value, and the output unit performs the first operation. The output value from the power source for the second period, which is a period of temperature rise than the period, is the second output value, and the power source for the third period is the temperature rise completion period in the vicinity of the temperature set by the output unit When the output value from the power source is the fourth output value for the fourth period, which is the period in which the output value from is set to the third output value and is in a stable state at the set temperature, the first period, The biological body estimated by the second calculation unit using the table or expression of the correlation of the temperature difference with respect to each output value in at least two periods of the second period, the third period, and the fourth period Based on the tissue temperature, Biological tissue bonding system according to claim 1, characterized in that to control.   The control unit sets an output value from the power source for a first period, which is a period in which the temperature of the output unit rises immediately after the start of output of the treatment energy, as a first output value, and the output unit performs the first operation. The output value from the power supply for the second period, which is a period of temperature rise than the period, is the second output value, and the power supply for the third period is the temperature rise completion period close to the temperature set by the output unit When the output value from the power source for the fourth period, which is a period in which the output value is stable at the set temperature, is the fourth output value, the respective output values in the respective periods. The power supply is controlled based on a living tissue temperature estimated by the second calculation unit using a table or an expression of a correlation of the temperature difference with respect to an output value of Biological tissue bonding system.   The control unit sets an output value from the power source for a first period, which is a period in which the temperature of the output unit rises immediately after the start of output of the treatment energy, as a first output value, and the output unit performs the first operation. The output value from the power supply for the second period, which is a period of temperature rise than the period, is the second output value, and the power supply for the third period is the temperature rise completion period close to the temperature set by the output unit When the output value from the power source for the fourth period, which is a period in which the output value is stable at the set temperature, is the fourth output value, the respective output values in the respective periods. The power supply is controlled based on a living tissue temperature estimated by the second calculation unit using a table or an expression of the correlation of the temperature difference with respect to the output value of Treatment tool control device.   The control unit sets an output value from the power source for a first period, which is a period in which the temperature of the output unit rises immediately after the start of output of the treatment energy, as a first output value, and the output unit performs the first operation. The output value from the power supply for the second period, which is a period of temperature rise than the period, is the second output value, and the power supply for the third period is the temperature rise completion period close to the temperature set by the output unit When the output value from the power source for the fourth period, which is a period in which the output value is stable at the set temperature, is the fourth output value, the respective output values in the respective periods. The power supply is controlled based on a living tissue temperature estimated by the second calculation unit using a table or an expression of a correlation of the temperature difference with respect to an output value of Creation of tissue bonding system Method.

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